Children

Children

Children are defined as people aged between 0 and 14 years of age.[25] In Australia, around one in five people (18% of the whole population) are in this age group.[24]

Aboriginal and Torres Strait Islander people have a relatively younger age profile than the non-Indigenous population. Aboriginal and Torres Strait Islander children represent 33% of the total Aboriginal and Torres Strait Islander population and 5.7% of the total child population in Australia.[24][31]

People identifying as belonging to diverse populations may identify across multiple priority population groups. This intersectionality can result in compounding impacts of social, cultural, commercial and environmental determinants of health on cancer experiences and outcomes.

Current state

In 2023, it is estimated that 741 children will be diagnosed with cancer, and 87 children will die from cancer. Between 2008 and 2017, the 5-year survival after a cancer diagnosis for children was 87%.[3][32]

Survivors of childhood cancer are at high risk of adverse long-term health conditions due to their cancer and associated treatment. These include second cancers and a range of serious, chronic health conditions that carry significant morbidity and mortality.[32]

Cancers in children are often different from those observed in adults in appearance, site of origin, and response to treatment. They can be caused by DNA changes in cells that occur very early in life, sometimes even before birth. Unlike many cancers in adults, childhood cancers are not strongly linked to lifestyle or environmental factors.[33][34]

Children with cancer and their families have unique needs that require specialist skill, equipment, and services including timely access to palliative care and bereavement support. A significant proportion of children who undergo cancer treatments also experience the risk of infertility.[35] In addition, children with cancer experience many psychosocial challenges due to disruptions in school attendance, recreational activities, and socialisation.[36]

Future state

The Australian Cancer Plan aims to improve health equity for children. This includes enhancing research opportunities into the risk factors and potential causes of genetic disorders and childhood cancers and expanding access to risk-modified screening including genomic testing for children. Other aims include improving access to drugs, new treatments and treatments that enable personalised medicine, and providing specialised education and training to healthcare providers to enable clinicians to have appropriate conversations with children and families.

Key Frameworks, Strategies, and Relevant Plans

National Action Plan for the Health of Children and Young People 2020–2030

Year: 2019
Author: Department of Health and Aged Care, Australian Government

The National Action Plan for the Health of Children and Young People 2020–2030 outlines the national approach to improving health outcomes for all children and young people. It aims to ensure that children and young people from all backgrounds have the same opportunities to fulfil their potential. This includes addressing chronic conditions, such as childhood cancer.

https://www.health.gov.au/resources/publications/national-action-plan-for-the-health-of-children-and-young-people-2020-2030

Early Years Strategy

Year: In development
Author: Department of Social Services, Australian Government

The Early Years Strategy (the Strategy) recognises how critical the early years are for children’s development and continued success over their lifetime. The strategy aims to deliver the best possible outcomes for Australian children by helping the Commonwealth create a more integrated, holistic approach to the early years and better support the education, wellbeing and development of children.

https://www.dss.gov.au/families-and-children-programs-services/early-years-strategy

Healthy Kids, Healthy Futures

Year: 2021
Author: Victorian Department of Health

The Healthy Kids, Healthy Futures 5-year plan aims to support children and young people to be healthy, active, and well. The plan has a strong focus on supporting physical and cognitive development to prevent the onset of chronic diseases in later life.

https://www.health.vic.gov.au/health-strategies/healthy-kids-healthy-futures

It takes a Tasmanian village: Child and Youth Wellbeing Strategy

Year: 2021
Author: Tasmanian Government

Tasmania’s Child and Youth Wellbeing Strategy provides direction for the government to improve the wellbeing outcomes for Tasmanian children and young people. One of the focus areas includes enhancing access to health and wellbeing services by establishing a Children’s Cancer Clinical Trials unit.

https://wellbeing.tas.gov.au/#%3A%7E%3Atext%3DThis%20%24100%20million%20Strategy%20provides%2Cfirst%201%2C000%20days%20of%20life

Best Opportunities in Life – Child and Adolescent Health and Wellbeing Strategic Plan 2018–2028

Year: 2018
Author: Northern Territory Government

The Northern Territory’s Child and Adolescent Health and Wellbeing Strategic Plan aims to protect, improve, and sustain the health and wellbeing of children and young Territorians. The plan advocates for strategic investment and a focus on factors that support children and young people so they can achieve their full potential.

https://health.nt.gov.au/professionals/child-and-youth-health-health-professionals

Children’s Health and Wellbeing Services 2018–2028

Year: 2017
Author: Queensland Health

The Children’s Health and Wellbeing Services Plan 2018–2028 aims to improve the health status of children and young people in Queensland, while safeguarding the equity of health outcomes and improving service access across the population.

https://www.childrens.health.qld.gov.au/chq/about-us/strategies-plans/

Healthy, Safe and Well: A Strategic Health Plan for Children, Young People and Families 2014–24

Year: 2014
Author: NSW Health

NSW’s Strategic Health Plan for Children, Young People and Families 2014–24 provides a comprehensive planning, service, and policy roadmap for NSW Health from preconception to 24 years of age, addressing the health of women and their partners during pregnancy, babies, children, and young people in the context of their families and communities.

https://www.health.nsw.gov.au/kidsfamilies/Pages/healthy-safe-well-2014-24.aspx

Implementation considerations

Maximising cancer prevention and early detection
Enhanced consumer experience
World class health systems for optimal care
Strong and dynamic foundations
Workforce to transform the delivery of cancer care
Achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander people

Stakeholder input

Children experience delayed cancer diagnoses, in part because they have difficulty communicating symptoms. Parents and carers report feelings of guilt when it takes multiple appointments before symptoms are appropriately investigated and diagnosis occurs. Delays in diagnosis are exacerbated for children within other priority population groups, including Aboriginal and Torres Strait Islander children, children from diverse backgrounds, children in lower socioeconomic groups, and children living in rural and remote areas.

2 Years
5 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Provide enhanced support for parents and carers where lifestyle behaviours are relevant in childhood cancers.
  • Research on the risk factors and genetic causes of childhood cancer.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further research on the impact of early childhood environment, parental income, food security, housing stability, and access to early childhood healthcare practitioners on cancer outcomes for children.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Assessment of the considerations unique to children diagnosed with cancer, including the role of genetic testing for inherited and acquired genetic mutations.
-

2 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Provide enhanced support for parents and carers where lifestyle behaviours are relevant in childhood cancers.
  • Research on the risk factors and genetic causes of childhood cancer.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further research on the impact of early childhood environment, parental income, food security, housing stability, and access to early childhood healthcare practitioners on cancer outcomes for children.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Assessment of the considerations unique to children diagnosed with cancer, including the role of genetic testing for inherited and acquired genetic mutations.
-

5 Years

Actions

1.5.3
Implement new, and improve existing, evidenced-based, risk-stratified cancer screening programs.
  • Risk-stratified cancer screening programs to include factors specific to childhood cancer and screening for inherited or acquired genetic mutations that have been shown to increase the risk of cancer.
  • Delivery of informative resources for families and carers on the importance of risk-stratified cancer screening programs for children.
-
1.5.4
Develop a policy framework for genomics in cancer control across the cancer care continuum.
  • Policy framework to include direction on engagement with, and inclusion of, children and their families and carers.
  • Policy framework to include direction on the screening of acquired and mutated genes common among children with cancer and how to seek parental consent in the delivery of genetic testing.
-

Maximising cancer prevention and early detection

Stakeholder input

Children experience delayed cancer diagnoses, in part because they have difficulty communicating symptoms. Parents and carers report feelings of guilt when it takes multiple appointments before symptoms are appropriately investigated and diagnosis occurs. Delays in diagnosis are exacerbated for children within other priority population groups, including Aboriginal and Torres Strait Islander children, children from diverse backgrounds, children in lower socioeconomic groups, and children living in rural and remote areas.

2 Years
5 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Provide enhanced support for parents and carers where lifestyle behaviours are relevant in childhood cancers.
  • Research on the risk factors and genetic causes of childhood cancer.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further research on the impact of early childhood environment, parental income, food security, housing stability, and access to early childhood healthcare practitioners on cancer outcomes for children.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Assessment of the considerations unique to children diagnosed with cancer, including the role of genetic testing for inherited and acquired genetic mutations.
-

2 Years

Actions

1.2.1
Deliver cancer prevention and health promotion activities, including healthy lifestyles, immunisation, and population screening participation, co-designed and tailored to a range of settings.
  • Provide enhanced support for parents and carers where lifestyle behaviours are relevant in childhood cancers.
  • Research on the risk factors and genetic causes of childhood cancer.
-
1.2.3
Promote translational research on the impact of social, cultural, commercial and environmental determinants of health on cancer outcomes for priority populations to inform policy and practice.
  • Further research on the impact of early childhood environment, parental income, food security, housing stability, and access to early childhood healthcare practitioners on cancer outcomes for children.
-
1.2.4
Undertake ongoing assessment of the evidence for risk-based, cost-effective population cancer screening.
  • Assessment of the considerations unique to children diagnosed with cancer, including the role of genetic testing for inherited and acquired genetic mutations.
-

5 Years

Actions

1.5.3
Implement new, and improve existing, evidenced-based, risk-stratified cancer screening programs.
  • Risk-stratified cancer screening programs to include factors specific to childhood cancer and screening for inherited or acquired genetic mutations that have been shown to increase the risk of cancer.
  • Delivery of informative resources for families and carers on the importance of risk-stratified cancer screening programs for children.
-
1.5.4
Develop a policy framework for genomics in cancer control across the cancer care continuum.
  • Policy framework to include direction on engagement with, and inclusion of, children and their families and carers.
  • Policy framework to include direction on the screening of acquired and mutated genes common among children with cancer and how to seek parental consent in the delivery of genetic testing.
-

Enhanced consumer experience

Stakeholder input

Stakeholders indicated that children and their families are uniquely impacted by a cancer diagnosis, particularly in terms of participation in educational and social activities, disruption to social networks, and limited support for families, including in areas of psychosocial support, palliative care, and bereavement.

Community organisations were identified as a trusted source for children and families to access the care they need where they need it, including when they return home.

Co-designed, tailored health care that enables children and their families to navigate complex health and cancer care, supported by communities, is important to improve experiences and equitable outcomes for children and families affected by cancer.

2 Years

Actions

2.2.1
Develop a national framework for and implement integrated multi-channel, multi-disciplined navigation models that ensure the right support at the right time for every consumer across the cancer continuum.
  • Integrated multi-channel, multi-disciplined navigation models to consider the role of families and carers in care navigation and the unique difficulties associated with childhood cancers. This could include specific childhood cancer peer navigators or provision of support closer to home to minimise disruption to schooling and social activities.
-
2.2.2
Improve availability of co-designed, tailored information and care for consumers to improve health literacy and reduce cancer-related stigma.
  • Co-design tailored resources for children experiencing cancer, their families and carers.
  • Utilise digital tools such as mobile applications in the delivery of information and care.
-

2 Years

Actions

2.2.1
Develop a national framework for and implement integrated multi-channel, multi-disciplined navigation models that ensure the right support at the right time for every consumer across the cancer continuum.
  • Integrated multi-channel, multi-disciplined navigation models to consider the role of families and carers in care navigation and the unique difficulties associated with childhood cancers. This could include specific childhood cancer peer navigators or provision of support closer to home to minimise disruption to schooling and social activities.
-
2.2.2
Improve availability of co-designed, tailored information and care for consumers to improve health literacy and reduce cancer-related stigma.
  • Co-design tailored resources for children experiencing cancer, their families and carers.
  • Utilise digital tools such as mobile applications in the delivery of information and care.
-

World class health systems for optimal care

Stakeholder input

Children experiencing cancer have unique clinical needs and require specialised assessment and interventions, which can be supported by dedicated care pathways and standards for best practice care.

2 Years

Actions

3.2.1
Develop and implement a national framework that standardises the development, update, evaluation and uptake of Optimal Care Pathways (OCPs), including for priority population groups.
  • National framework that provides specific engagement and support to children, families and carers, providing cancer care information in an appropriate manner to children and maintaining participation in social activities, where possible.
-
3.2.2
Develop a national framework for networked, distributed comprehensive cancer care, to facilitate provision of services as close as safely possible to where patients live. This will include the role of Comprehensive Cancer Centres to enhance patient outcomes, strengthen transparency and accountability, and drive continuous improvements for all patients across the network regardless of where the care is provided.
  • National framework for networked comprehensive cancer care designed to incorporate collaboration of comprehensive cancer centres with paediatric hospitals and clinicians to provide the highest level of integrated and quality care.
-
3.2.3
Implement innovative, evidence-based and cost-effective models of care for people living with and beyond cancer.
  • Innovative, evidence-based models of care for children that incorporate the views of the children, families, and carers, and include multidisciplinary teams with expertise in paediatric oncology and other paediatric specialists.
-
3.2.4
Develop and refine integrated care models to maximise access to high-quality, timely and evidence-based palliative and end-of-life care, including voluntary assisted dying.
  • Integrated care models that provide palliative care, advance care planning, and end-of-life care training for paediatric oncologists and healthcare practitioners working with children.
  • Integrated care models that provide access to palliative care, advance care planning, and end-of-life care information and resources tailored to children engaging with palliative and end-of-life care, including for their carers and families.
-

2 Years

Actions

3.2.1
Develop and implement a national framework that standardises the development, update, evaluation and uptake of Optimal Care Pathways (OCPs), including for priority population groups.
  • National framework that provides specific engagement and support to children, families and carers, providing cancer care information in an appropriate manner to children and maintaining participation in social activities, where possible.
-
3.2.2
Develop a national framework for networked, distributed comprehensive cancer care, to facilitate provision of services as close as safely possible to where patients live. This will include the role of Comprehensive Cancer Centres to enhance patient outcomes, strengthen transparency and accountability, and drive continuous improvements for all patients across the network regardless of where the care is provided.
  • National framework for networked comprehensive cancer care designed to incorporate collaboration of comprehensive cancer centres with paediatric hospitals and clinicians to provide the highest level of integrated and quality care.
-
3.2.3
Implement innovative, evidence-based and cost-effective models of care for people living with and beyond cancer.
  • Innovative, evidence-based models of care for children that incorporate the views of the children, families, and carers, and include multidisciplinary teams with expertise in paediatric oncology and other paediatric specialists.
-
3.2.4
Develop and refine integrated care models to maximise access to high-quality, timely and evidence-based palliative and end-of-life care, including voluntary assisted dying.
  • Integrated care models that provide palliative care, advance care planning, and end-of-life care training for paediatric oncologists and healthcare practitioners working with children.
  • Integrated care models that provide access to palliative care, advance care planning, and end-of-life care information and resources tailored to children engaging with palliative and end-of-life care, including for their carers and families.
-

Strong and dynamic foundations

Stakeholder input

Resources allocated to childhood cancers need to be increased as part of sustainable funding arrangements, to allow for improvements in early access to new therapies for children. Increased investment into childhood cancer research across the continuum of care is needed, particularly into a new generation of molecularly targeted anti-cancer therapies. The exploration of genomic, functional, biological, and clinical data to drive improved understanding of the growth of childhood cancers was also highly supported.

2 Years

Actions

4.2.2
Ensure targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access.
  • Prioritise targeted research to better understand cancer risks and experiences of children.
  • Improve access to clinical trials for children, with consideration to expanding age thresholds to clinical trials.
  • Encourage industry support to commercialise treatments tailored specifically for childhood cancers.
-
4.2.3
Identify opportunities to improve equitable cancer care through the digital health ecosystem.
  • Information and guidance for families and carers on how a digital health ecosystem is integrated alongside OCPs to ensure children have opportunities to continue participating in school and social activities where possible.
  • Engage with families and carers to obtain informed consent to participate in virtual care.
  • Digital health ecosystem that ensures children do not feel excluded from consultations and remain informed about their care and treatment.
  • Digital health ecosystem designed to be user-friendly for children, for example using tailored apps.
-

2 Years

Actions

4.2.2
Ensure targeted and innovative research investment into areas of unmet and emerging need; and improve clinical trial design and equitable access.
  • Prioritise targeted research to better understand cancer risks and experiences of children.
  • Improve access to clinical trials for children, with consideration to expanding age thresholds to clinical trials.
  • Encourage industry support to commercialise treatments tailored specifically for childhood cancers.
-
4.2.3
Identify opportunities to improve equitable cancer care through the digital health ecosystem.
  • Information and guidance for families and carers on how a digital health ecosystem is integrated alongside OCPs to ensure children have opportunities to continue participating in school and social activities where possible.
  • Engage with families and carers to obtain informed consent to participate in virtual care.
  • Digital health ecosystem that ensures children do not feel excluded from consultations and remain informed about their care and treatment.
  • Digital health ecosystem designed to be user-friendly for children, for example using tailored apps.
-

Workforce to transform the delivery of cancer care

Stakeholder input

The health workforce needs to be culturally competent in caring for children with cancer and their families. Increased training and awareness for cancer care practitioners working with children will assist health professionals to understand the importance of social support during a child’s cancer care.

Workforce planning for childhood cancer care needs to be improved to match workforce planning initiatives in adult cancer care.

The lack of funding in dedicated childhood cancer research was noted. This can impact the number of clinicians and medical scientists who might consider entering paediatric cancer research.

2 Years
5 Years

Actions

5.2.1
Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.
  • Model the distribution of cancer care practitioners trained in treating paediatrics, e.g., childhood cancer specialists and researchers, child psychosocial services and/or additional support for families.
  • Future forecasting of the primary care workforce’s ability to deliver paediatric cancer care, particularly in rural and remote areas.
-
5.2.2
Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.
  • Extend the scope of practice of those working in paediatric medicine to provide supportive care, navigation assistance and survivorship care for children with cancer.
-

2 Years

Actions

5.2.1
Identify current and emerging workforce undersupply in line with cancer workforce modelling and other national health workforce strategies, and initiate planning with the sector towards building future workforce capacity and capability.
  • Model the distribution of cancer care practitioners trained in treating paediatrics, e.g., childhood cancer specialists and researchers, child psychosocial services and/or additional support for families.
  • Future forecasting of the primary care workforce’s ability to deliver paediatric cancer care, particularly in rural and remote areas.
-
5.2.2
Build on existing capability of the primary care workforce to collaboratively and sustainably support the needs of consumers.
  • Extend the scope of practice of those working in paediatric medicine to provide supportive care, navigation assistance and survivorship care for children with cancer.
-

5 Years

Actions

5.5.2
Assist the sector to support all cancer care practitioners to work at the top of their scope of practice, increase retention and ensure ongoing access to continuing professional development.
  • Improve resources and investment in dedicated childhood cancer research to support aspiring cancer care practitioners to enter the paediatric field.
  • Increase professional development on communicating appropriately with children and their families during difficult conversations on prognosis, death and dying, and palliative care.
-

Achieving equity in cancer outcomes for Aboriginal and Torres Strait Islander people

The Australian Cancer Plan considers an intersectional and health equity approach for Aboriginal and Torres Strait Islander people. This is more than recognising the multiple backgrounds, experiences, and ways Aboriginal and Torres Strait Islander people identify. This approach addresses the way membership of multiple groups may impact people's health and wellbeing needs and ability to access care.

Implementation of each action should consider the compounding impacts of intersectionality across other priority population groups.

2 Years
5 Years

Actions

6.2.1
Embed Aboriginal and Torres Strait Islander voices in policymaking on cancer prevention, care delivery and standards through leadership, collaboration and co-design processes.
6.2.2
Strengthen collaboration with service providers, regulatory authorities and the Aboriginal and Torres Strait Islander cancer workforce to establish clear accountability for culturally safe care and compliance with national standards.
6.2.3
Establish and enhance collaborative partnerships with communities and Aboriginal and Torres Strait Islander-led organisations.

2 Years

Actions

6.2.1
Embed Aboriginal and Torres Strait Islander voices in policymaking on cancer prevention, care delivery and standards through leadership, collaboration and co-design processes.
6.2.2
Strengthen collaboration with service providers, regulatory authorities and the Aboriginal and Torres Strait Islander cancer workforce to establish clear accountability for culturally safe care and compliance with national standards.
6.2.3
Establish and enhance collaborative partnerships with communities and Aboriginal and Torres Strait Islander-led organisations.

5 Years

Actions

6.5.1
Establish ongoing place-based engagement with Aboriginal and Torres Strait Islander people to understand emerging needs across the cancer care continuum.
6.5.2
Implement strategies to embed culturally safe care within cancer-related services for Aboriginal and Torres Strait Islander people.

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